ABSTRACT
Objective: To determine the frequency of
erectile dysfunction in a referral diabetic clinic and the rate of
self-reporting in relation to age and duration of diabetes.
Methods:
A group of 258 males were interviewed in the diabetic clinic in the
first half of 2001. Mean age (± standard deviation) was 52.3±10.62
(range 35-75 years) with mean duration of diabetes of 9.8±6.8 years.
About 6% of the sample had type 1 diabetes and 94% had type 2 diabetes.
Results:
The duration of erectile dysfunction was 33.8±27.6 months (1.5-120
months). Erectile dysfunction was found in 67.4 % (n=174) of the
interviewed patients. Only 40.2% (n= 70) of patients reported erectile
dysfunction, which was directly proportionate to age. Higher frequency
of erectile dysfunction was found in patients with duration of >10
years but with a lower self-report rate.
Conclusion: The
frequency of self-reporting is, however, low. Erectile dysfunction
should be looked for routinely as part of the follow-up in the diabetic
clinic and treated accordingly.
Key words: Erectile dysfunction, Self-report, Diabetes mellitus
JRMS Dec 2002; 9(2): 19-22
IntroductionErectile dysfunction (ED); the inability to attain and maintain a penile erection sufficient to permit satisfactory sexual intercourse (1), has a general frequency of 5.2% in the outpatient clinics (2), and reaches almost 60% in diabetics (3).
Aging, hypertension, diabetes mellitus (DM) and ischemic heart disease are among several other variables implicated in the etiology of ED (2). Moreover; vasculopathy (4,5) and neuropathy (6,7), are additional etiologies implicated in diabetic patients.
Commonly, ED in DM develops insidiously over a period of months to years (8). ED, however, is not a late complication of the disease but can occur early in the natural history of the disease or as a first presentation (9).
Pertulla (10) found that physicians initiate discussion about ED in 17% of patients with hypertension, 18% of those with diabetes and in 30% of patients aged 65 years and above.
Erectile dysfunction is an overlooked diagnosis in diabetic patients in our part of the world, for it is considered a taboo to be discussed due to its relation with male dominance and self esteem. In addition, to the patient's embarrassment is the lack of the physicians' time to discuss these issues.
So this study was conducted to determine the frequency of ED in a referral diabetic clinic and to find the rate of self-reporting in this group in relation to age and duration of diabetes.
Methods Two hundred and fifty eight diabetic males aged between 35-75 years were seen in the diabetic clinic at King Hussein Medical Center in Amman-Jordan between January and June 2001. Ninety four percent of the cohort had type 2 diabetes.
All patients were married and 99% had one or more children.
The visit consisted of complete physical examination, assessing the diabetic control and asking patients about any problems they encountered.
If not self-reporting any ED, then patients were asked specifically about it and the patterns and duration of ED.
All associated conditions, possible risk factors, smoking, alcohol habits and drug history were also reported.
Patients were divided into four groups according to their age: Group 1 (35-44 years) 70 patients (27%); group 2 (45-54 years) 76 patients (29.4%); group 3 (55-64 years) 82 patients (32%) and group 4 (65-75 years) 30 patients (11.6%). According to the duration of diabetes patients were divided into five groups: Group 1 with a duration of DM ≤ 5 years 90 patients (34.9%), group 2 with a duration of DM (6-10 years) 62 patients (24%), group 3 with a duration of DM (11-14 years) 46 patients (17.8%), group 4 with a duration of DM (15-20 years) 40 patients (15.5%), and group 5 with a duration of DM of > 20 years 20 patients (7.8%). The frequency of ED and the rate of self-report were recorded in each group.
Statistical methods used included percentages, mean, standard deviation and ranges.
Results Mean age of the patients (± standard deviation) was 52.3± 10.62 range (35-75) years. The mean duration of DM was 9.8±6.8 years. (range 0.4-30). About 6.1% of the sample had type 1 diabetes. Mean HbA1c was 7.98±2.3%. Eighty-one patients (31.4%) had good glycemic control (HbA1c≤7%) and 177 patients (68.6%) had poor glycemic control (HbA1c>7%). Of those with a good glycemic control 41 patients (50.6%) had ED, while of those with a poor glycemic control 133 patients (75.1%) had ED. The mean duration of ED was 33.8 ± 27.6 months (1.5-120).
Erectile dysfunction was found in 67.4% (n= 174) of patients. The frequency of self-report of ED was 40.2% (n= 70). The onset of ED was sudden in 33% and gradual in 67%.
Smoking was found in 92 patients (35.7%). ED was found in 79.4% of the smokers and in 54.6% of the non-smokers. Moderate alcohol consumption (<21 units /week) was present in 3 patients (1.2%) and all of them had ED.
The current medications for diabetes are shown in Table I. The majority was receiving oral hypoglycemic agents (58.9%) followed by insulin in one third of patients. The frequency of ED and rate of self-report of ED according to each age group and duration of diabetes are shown in Figures 1 and 2.
Table I. The current medical therapy for
diabetes
|
Drugs
|
No.
|
%
|
|
Diet
|
4
|
1.6
|
|
Sulphonylurea ± Metformin
|
152
|
58.9
|
|
Repaglinide
|
4
|
1.6
|
|
Insulin+Metformin
|
12
|
4.6
|
|
Insulin
|
86
|
33.3
|
Fig. 1. Frequency of ED and rate of self -report ED in relation to age.
(n=Number of patients in that group)
Fig. 2. Frequency of ED and rate of self-report ED in relation to the duration of diabetes.
(n=Number of patients in that group)
References
1. NIH Consensus Development Panel on Impotence. JAMA 1993; 270: 83.
2. Feidman HA, Goldstein I, Hatzichristou D.G. et al. Impotence and its medical and psychosocial correlates: Results of the Massachusetts Male Aging Study (MMAS). J of Urology 1994; 15 1:54-61.
3. McCulloch DK, Campbell IW, Wu FL, et al. The frequency of diabetic impotence. Diabetologia 1980; 18:279.
4. Takanami M, Naguo K, Ishii N, et al. Is diabetic neuropathy responsible for diabetic impotence? Urol Inter 1997; 58(3): 181-185.
5. Sullivan ME, Keoghane SR, Miller MAW. Vascular risk factors and erectile dysfunction. BJU Int 2001; 87: 838-845.
6. Veves A, Webster L, Chen TF, et al. Aetiopathogenesis and management of impotence in diabetic males: Four years experience from combined clinics. Diabet Med 1995; 12(1): 77-82.
7. Nehra A, Morelont RB. Neurologic erectile dysfunction. Urologic Clin N Am 2001; 28(2): 289-308.
8. Kolodny R C, Kahn C B, Goldstein A, et al. Sexual dysfunction in diabetic men. Diabetes 1989; 23: 306.
9. Hakim LS, Goldstein I. Diabetic sexual dysfunction. Endocrin Metab Cli North Am 1996; 25(2): 379-400.
10. Perttula E. Physician attitudes and behavior regarding erectile dysfunction in at-risk patients from rural community. Postgrad Med J 1999; 75:83-85.
11. Metz ME, Seifert Ml. Men's expectations of physician in sexual health concerns. J Sex Marital Ther 1990; 16: 79-88.
12. Al-Helali NS, Abolfotouh MA, Ghanem HM. Pattern of erectile dysfunction in Jeddah city. SMJ 2001: 22 (1): 34-38.
13. Slag MF, Morly JE, Elson MK, et al. Impotence in medical outpatient clinic. JAMA 1983; 249(13): 1736-1740.
14. Spector IP, Carey MP. Incidence and prevalence of sexual dysfunction: A critical review of the empirical literature. Arch Sex Behav 1990; 19: 389.
15. Diokno AC, Brown MB, Herzog AR. Sexual function in the elderly. Arch Intern Med 1990; 150:197.
16. Laumann EO, Paik A, Rosen R. Sexual dysfunction in the United States: Prevalence and Predictors. JAMA 1999; 21: 537.
17. Spector KR, Boyle M. The prevalence and perceived etiology of male sexual problems. A non-clinical sample. Br J Med Psychol 1996; 59: 351.
18. Bejin A. Epidemiological d'ejaculation prematuree et de son cumul avec la dysfonction erectile. Andrologie 1999; 9: 211.
19. Romeo JH, Seftel AD, Mahun ZT, et al. Sexual function in men with diabetes type 2: Association with glycaemic control. J Urol 2000; 163: 788-791.
20. Kattan S. Impotence in Saudi males. Etiology and risk factor. SMJ 1996; 17: 350-355.
21. Shorm S, Lief H, Wien A. Clinical profile of experience with 130 consecutive cases of impotent men. Urol 1979; 13; 511.
22. Carroll J, Ellis D, Bagley D. Impotence in elderly, evaluation of erectile failure in men older than seventy years of age. Urol 1992; 43: 266-230.